Head and Neck

Chapter 13

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 Head and Neck

• Complex exam (several structures)

– Skull encloses brain
– Face: eyes, ears, nose, mouth
– Neck: spine, esophagus, trachea, thyroid,
arteries, veins, lymph nodes

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 Health History: Head and Neck
• Present health status: changes, chronic
disease, medications (what/when), last
eye exam; glasses or contacts?
• Past medical history: surgery,
headaches (type), problems now?
• Family history: thyroid disease, type I
DM, myasthenia gravis, rheumatoid
arthritis, high blood pressure,
migraines?
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 Health History: Head and Neck
Problem-Based History
• Headache
– How long or often; gradual or sudden onset?
– Where occur; single area or generalized pain; when?
– Patterns, describe pain, intensity, other symptoms
(always/sometimes)
– When occur; lasts how long; pattern?
– Pain characteristics, intensity, aggravated by
movement?
– Other symptoms
– What brings on, other health problems, foods?
– How treated (what, effective, when)?
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 Health History: Head and Neck
Problem-Based History
• Dizziness
– Describe sensation; first begin, how often,
how long
– What do when occurs, makes worse or
better, interfere with ADL, how treated
– What causing, occur with driving or
machinery, ever fallen?

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 Health History: Head and Neck
Problem-Based History
• Neck pain or stiffness
– First noticed, constant or come and go, how long,
cause?
– What part of neck painful, radiate, numbness or
tingling, intensity?
– Limited neck motion, movement affects pain,
changes in ADLs, keep from sleeping or working?
– What makes worse or better, how treated?
– Other symptoms: been ill, fever, rash, headache?

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 Health History: Head and Neck
Problem-Based History
• Hoarseness or voice change
– How long experiencing, constant or come
and go, clear throat frequently, what makes
worse?
– Affected by weather, associated with cold
or sore throat?
– What makes better; treating effective?

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 Examination Techniques: Head
• Inspect face for characteristics of feature
symmetry, movement, and appropriateness
of expressions
• Inspect/palpate skull for contour, tenderness,
intactness
• Inspect/palpate/auscultate temporal arteries
• Inspect/palpate bony structures of face or jaw
for size, symmetry, intactness, tenderness
• Palpate TMJ for movement, tenderness,
discomfort
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 Examination Techniques: Neck

• Inspect for positioning relative to head or

trachea position
• Inspect for ROM
• Palpate for positioning of anatomic
structures, muscle tenderness, strength
• Inspect or palpate regional lymph nodes:
size, consistency, mobility, borders,
tenderness, warmth
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 Examination Techniques:

• Inspect anterior neck to visualize thyroid

• Auscultate for bruits

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 Age-Related Variations:
Older Adult
• Examination: procedures and
techniques
– ROM assessment one movement at a
time, not full rotation (avoids dizziness)
– Thyroid exam same as for adult
• Normal and abnormal findings
– Stiff neck associated with cervical arthritis

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 Common Problems and
Conditions: Headaches
• Most common medical complaint
• Recurrent headaches symptoms of
chronic primary headache disorder
• May be associated with ophthalmologic
problems, dental problems, sinusitis,
infections, side effects from
prescriptions, hemorrhage, tumor

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